Time to Loosen the Apron Strings: Cohort-based Evaluation of a Learner-driven Remediation Model at One Medical School

Abstract

BACKGROUND: Remediation in the era of competency-based assessment demands a model that empowers students to improve performance. AIM: To examine a remediation model where students, rather than faculty, develop remedial plans to improve performance. SETTING/PARTICIPANTS: Private medical school, 177 medical students. PROGRAM DESCRIPTION: A promotion committee uses student-generated portfolios and faculty referrals to identify struggling students, and has them develop formal remediation plans with personal reflections, improvement strategies, and performance evidence. Students submit reports to document progress until formally released from remediation by the promotion committee. PROGRAM EVALUATION: Participants included 177 students from six classes (2009–2014). Twenty-six were placed in remediation, with more referrals occurring during Years 1 or 2 (n = 20, 76 %). Unprofessional behavior represented the most common reason for referral in Years 3–5. Remedial students did not differ from classmates (n = 151) on baseline characteristics (Age, Gender, US citizenship, MCAT) or willingness to recommend their medical school to future students (p < 0.05). Two remedial students did not graduate and three did not pass USLME licensure exams on first attempt. Most remedial students (92 %) generated appropriate plans to address performance deficits. DISCUSSION: Students can successfully design remedial interventions. This learner-driven remediation model promotes greater autonomy and reinforces self-regulated learning.